Septal Perforations

A septal perforation is a hole in the nasal septum, the structure made of cartilage and bone that separates the nasal passages.

Septal Perforations can result from trauma, previous nasal surgery, aggressive cautery for nosebleeds, infections like tuberculosis, cocaine use, cancer, or diseases such as syphilis, vasculitis, lupus, or sarcoidosis.

This condition can develop for various reasons, including complications from previous nasal surgery, trauma to the nose, or aggressive cauterization used to stop nosebleeds. Infections such as tuberculosis, certain autoimmune diseases like vasculitis, lupus, and sarcoidosis, as well as cocaine use, can also contribute to the development of a septal perforation. In rare cases, it may be linked to cancer. Depending on the size and location of the perforation, symptoms can range from mild discomfort to nasal congestion, crusting, and recurrent nosebleeds, often requiring medical evaluation and treatment.

Stages of Septal Perforations

The stages of septal perforation can be understood through the progression of symptoms and treatment needs:

These stages include:

In the early stages, a local inflammatory response results in mucosal harm followed by swelling, erythema, and the development of crusts/scabs.

In the second stage, a reduction in vascularization along with infiltration with inflammatory cells is observed, which leads to loss of the overlying septal tissue and the start of cartilage death.

The third stage involves cartilage ulceration and necrosis. This is followed by changes to the tissue type at the edges of the perforation, resulting in recurrent crusting and bleeding.

When conservative treatments fail or the perforation continues to enlarge, surgical intervention may be necessary. Surgery to repair the perforation, such as septal button or local flap reconstruction, is often considered to restore the nasal structure, improve breathing, and resolve troublesome symptoms.

Factors, Symptoms, Diagnosing, and Beyond:

What are the common symptoms of septal perforations?

Some patients with septal perforations may have no symptoms, while others can experience recurrent nosebleeds, nasal discharge, crusting, nasal obstruction, and a whistling sound when breathing through the nose.

How are septal perforations diagnosed by an ENT specialist?

A thorough evaluation of septal perforations involves taking a detailed medical history, conducting a comprehensive head and neck examination, and potentially using additional diagnostic tests such as bloodwork, CT scans, or biopsies to determine the underlying cause and extent of the condition. These steps are essential for developing an appropriate treatment plan.

What are the best treatment options for septal perforations?

The best treatment options for septal perforations depend on the size and symptoms. Conservative options include avoiding the cause, using nasal saline sprays, lubricants, and a humidifier to relieve symptoms. For more severe cases, surgical options like inserting a septal button or using tissue from inside the nose to close small or medium-sized perforations may be recommended.